Nursing Gets Stranger Than We SupposeAs I write this, I know it will be seen by nursing students, nurses that are getting ready to take their NCLEX, new grads that have been on the job in their first few months, experienced nurses, and some nurses with more experience than I could imagine (probably more than they ever imagined they would have). [caption id="attachment_2546" align="aligncenter" width="1027"] (Note, when good old J.B.S. Haldane said the above (as did I), by “queerer” he meant something like ‘unexpected, stranger, unusual, etc.’)[/caption] Regardless of your experience level, most of us agree that things out here are generally pretty predictable - but, just when that thought kicks in, something, somehow, comes right out of left field. So, the good news is that most of what you do, or are going to do, has been covered by your studies or from your experience. You will run into things that just didn’t (and actually couldn’t) make it into nursing class and weren’t grilled about on the NCLEX. In order to be able to handle these things well, let me advise you that your career will demand that you be resilient and adaptable.
ResilienceResilience is being able to bounce back when you are challenged by people, situations, or circumstances. Starting out as a nurse, you’ll need a lot of that. Being resilient will also help you develop the persistence you’re going to need over the years. It will enable you to stay sharp in your practice when it gets routine, and committed during times when the workload gets heavy.
AdaptabilityAdaptability is being able to adjust to new situations or events. Being adaptable helps you bring your nursing mind into new contexts. There will also be times when you will bring unfamiliar contexts into your nursing mind- the nurse has to be able to do either as his or her career plays out. Admittedly, that all sounds a bit philosophical, so I’ll share a few real world stories of where adaptability and resilience were key in my being able to keep saying “I’m a nurse”.
Resilience requiredAs a new grad, and on my first unit, it was a real thrill to finally hit the floor. At that point, there’s lots of interaction with experienced nurses - Meet the team:
- I had one awesome ‘ad hoc’ mentor help me get to speed. A nurse like that can make your floor debut beautiful and cause you to feel grateful you chose a nursing career.
- Some nurses that treated me with ‘cynical clinical disdain’ (oh, those silly new grads think they know everything, but they really don’t know jack squat about the real world).
- There were nurse bullies who work to let you know you’re a drag on the team, clueless, hopeless, useless, and question who was buffaloed into giving you a license in the first place.
Being resilient, able to bounce back from withering criticism, and still determined to succeed and progress saved me from bully induced despair- and yes, it can and does happen. Lean into your mentors and bring your 'bounce back'!
Adapting to unexpected conditionsI had worked in medical-surgical, cardiac transition, and E.R. when an opportunity to work at the hospital’s hospice facility presented itself. Having a background in pastoral ministry training, I thought I could put that to good use along with patient care. It did work out well - but it takes a real shift in thinking to really embrace the hospice paradigm. The first week, I was with my preceptor. She and I were together in a room, and a patient was getting into some breathing difficulty, and we both nodded that oxygen via nasal cannula was a good idea for comfort. I turned away from my preceptor, and hurried out of the room (we all feel the urgency of the ABC’s- airway, breathing, circulation). As I was jogging to a hallway where the supplies were, my preceptor called out - “Steve!!” I hurried even quicker back to her side. She smiled, then, slowly and patiently, said to me “Walk.” I did. In ordinary nursing circumstances, quick stepping (or even running) are sometimes called for. But as my preceptor explained to me about hospice, nothing we did was “urgent”; and it was better for us always to have a calm, measured manner in going about our responsibilities. That made the overall atmosphere of the hospice much more peaceful and calm - a dignified and proper setting geared toward consideration of the patients we were helping.
Adapting and Resilience, Literally on the StreetIt was a sunshiny afternoon. I ended a good shift, gave a good report, and cleaned up the details, started up the car and the top tunes on the radio, and was be-bopping my way home. Uh oh. What’s this? There’s a small red truck stopped almost in the middle of an intersection, surrounded by police. I pulled over to look at the scene, as a man was lying on the ground outside the truck’s door, and no one was doing anything. Oh drat. My inner voice says “you’re a nurse, go look!” I park and walk over to the officer nearest the man and say “Hi, I’m an RN, what’s up?” As I look down, I see the man is turning blue, and a handful of needles have fallen to the street outside the truck’s door. As the officer tells me “looks like the guy’s OD’d, we’ve got rescue on the way”, I had already bent down to see and feel he had a pulse, but was in respiratory arrest. Not your average Tuesday. Mid-thirties, otherwise relatively healthy looking man lying in the street, you still don’t hear the ambulance sirens, he’s getting blue, the officers can’t do anything, and I sure as heck don’t have a resuscitation mouth guard in my pocket. Ok, time to adapt. I hyperextend the man’s neck, his mouth falls open, and is clear. One hand pinches his nostril, the other hand under his chin supports while thumb and index finger circle around the mouth opening to form a makeshift mouth guard so we hopefully don’t end up swapping saliva. Pulse stays good. Three big blows into his lungs later, he starts to pink up. Five minutes later, he starts to breathe on his own again- just as the rescue squad pulls up. Rescue was all over the man, O2 and Ambu bag/mask applied and on the gurney right quick. As I left, I reflected on the possible anoxic brain injury from the slow response. I followed up the next day, and found he survived just fine and checked himself out of the ER the next morning. I need to add here that every state has some form of “good Samaritan” law, and some states have “duty to rescue” laws, and it’s a good idea to know the laws relating to your particular state. Take a moment to find out what they are. Mostly, you’re protected if you don’t do anything outrageously negligent- but it’s good to know. Never thought that would happen to me, and I would have bet my nursing pin that it wouldn’t happen again. But it did, two more times, totally different scenarios, life or death in the balance. Fortunately chalked up two more, completely unexpected, wins. That’s a story for another day. As you go, the stories will pile up, and you’ll know that resilience and adaptability, added to your nursing mind and training, will be two qualities you’ll never be sorry you cultivated.
Nursing can get stranger than you, or I, even can suppose. Stay ready.